Six Developmental Trajectories Characterize Children With Autism

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Autism is widely considered a heterogeneous disorder in terms of etiology and phenotype. Although autism is usually a lifelong disorder, little is known about the rate or timing of how children develop regarding their communication and social functioning. WHAT THIS STUDY ADDS:Utilizing annual evaluations for a large population of children with autism, we describe the 6 most common trajectories from diagnosis through age 14 years. Trajectories revealed considerable variation, and high socioeconomic status children were more likely to experience rapid improvement.abstract OBJECTIVE: The goal of this study was to describe the typical longitudinal developmental trajectories of social and communication functioning in children with autism and to determine the correlates of these trajectories. METHODS:Children with autism who were born in California from 1992 through 2001 and enrolled with the California Department of Developmental Services were identified. Subjects with ,4 evaluations present in the database were excluded, resulting in a sample of 6975 children aged 2 to 14 years. Score sequences were constructed based on 9 evaluative items for social, communication, and repetitive behavior functioning. Typical trajectories were identified by using group-based latent trajectory modeling, and multinomial logistic regression models were used to determine the odds of classification within each trajectory varied by individual and family-level factors.RESULTS: Six typical patterns of social, communication, and repetitive behavior functioning were identified. These trajectories displayed significant heterogeneity in developmental pathways, and children whose symptoms were least severe at first diagnosis tended to improve more rapidly than those severely affected. One group of ∼10% of children experienced rapid gains, moving from severely affected to high functioning. Socioeconomic factors were correlated with trajectory outcomes; children with non-Hispanic, white, well-educated mothers were more likely to be high functioning, and minority children with less-educated mothers or intellectual disabilities were very unlikely to experience rapid gains.CONCLUSIONS: Children with autism have heterogeneous developmental pathways. One group of children evidenced remarkable developmental change over time. Understanding what drives these outcomes is thus critical.

ASD Validity

“…Understanding the developmental course of ASD is crucially important for managing life care and planning treatment. However, ASD occurs with many varied developmental paths (Fountain et al 2012;Lord et al 2015), and there is no one consistent life outcome (Fein et al 2013;Helles et al 2015;Steinhausen et al 2016). Variation in ASD developmental course has ranged from typical development in infancy that becomes atypical in early childhood, to marked infant impairment in social and cognitive skills that changes to become optimal adaptive functioning in adulthood (Anderson et al 2014;Fein et al 2013;Fountain et al 2012;Helles et al 2015;Howlin et al 2013;Levy and Perry 2011;Lord et al 2015;Yirmiya and Charman 2010).…”

“…The only broadly successful ASD treatment has been early behavioral intervention programs (Kasari 2015;Schreibman et al 2015;Smith and Iadarola 2015;), but these treatments are not unique to ASD (Losinski et al 2014), and the long-term effectiveness of these programs is not yet known (Fernell et al 2011. Researchers who studied infant siblings of children with ASD concluded no single early behavior could predict ASD diagnoses (Zwaigenbaum et al 2015), and ASD has been found with widely varied trajectories of development (Fountain et al 2012;Lord et al 2015) and varied life outcomes (Fein et al 2013;Helles et al 2015;Steinhausen et al 2016). …”

Trajectories and Outcomes Among Children With Special Health Care Needs

“…Although children with medical homes have fewer unmet needs, 27 gaps in both health 28 and education 29 still exist and are associated with poorer outcomes. 30,31 Future research should examine whether certain conditions are more likely to be associated with different trajectories 11,12 and, taking a life course approach, whether the timing or age at which SHCN are experienced also influence outcomes, over and above the pattern of the longitudinal profile. It will also be important to clarify the extent to which the risk and protective factors identified in conceptual models, such as those presented by O'Connor et al 32 and Newacheck et al, 13,14 explain differences in children's outcomes based on their longitudinal SHCN profile.…”

“…11,12 There is currently limited knowledge about the natural history and variability over time of SHCN as a broad grouping and about how outcomes may vary by differing trajectories (eg, emerging, persistent), if such exist. 11 Newacheck et al 13,14 and, more recently, Bethell et al 15 have argued that this missing longitudinal information is crucial to inform the planning of medical, developmental, and education support services for these children across their life course.…”

The Population Level Impacts of Differential Fertility Behavior of Parents of Children with Autism

“…4 These data were linked to the BMF using probabilistic matching (for details on the linkage, see King and Bearman 2011) and include each child's date of first evaluation at the DDS as well as five items that measure social and three items that measure communication functioning. We use an equally weighted index of these sets of items to construct age-adjusted social and communication severity scores for each child measured on scales ranging from 1 to 100 (for details on the construction and distributions of the developmental functioning scores, see Fountain, Winter, and Bearman 2012). We consider children with scores below 25 at first DDS evaluation to be low functioning.…”